Clinical features of hypertriglyceridemia-induced acute pancreatitis in an international, multicenter, prospective cohort (APPRENTICE consortium)

Ioannis Pothoulakis, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; MedStar Washington Hospital Center, Washington, DC, USA.
Pedram Paragomi, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Livia Archibugi, Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; Digestive and Liver Disease Unit, Sant Andrea Hospital, Rome, Italy.
Marie Tuft, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Rupjyoti Talukdar, Asian Gastroenterology Institute, Hyderabad, India.
Rakesh Kochhar, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Mahesh Kumar Goenka, Apollo Gleneagles Hospitals Kolkata, Kolkata, India.
Aiste Gulla, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Vikesh K. Singh, John Hopkins Medical Institution, Baltimore, MD, USA.
Jose A. Gonzalez, Universidad Autónoma de Nueva León, Monterrey, Mexico.
Miguel Ferreira, Hospital Nacional de Itaguá, Itagua, Paraguay.
Sorin T. Barbu, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
Tyler Stevens, Cleveland Clinic Foundation, Cleveland, USA.
Haq Nawaz, Eastern Maine Medical Center, Maine, Bangor, USA.
Silvia C. Gutierrez, Hospital Nacional "Profesor Alejandro Posadas", Buenos Aires, Argentina.
Narcis O. Zarnescu, University of Medicine and Pharmacy, Bucharest, Romania.
Jeffrey Easler, Indiana University School of Medicine, Indianapolis, IN, USA.
Konstantinos Triantafyllou, Attikon University General Hospital, Athens, Greece.
Mario Pelaez-Luna, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad Autónoma de Mexico, Mexico City, Mexico.
Shyam Thakkar, Allegheny General Hospital, Pittsburgh, PA, USA.
Carlos Ocampo, Hospital General de Argudos "Dr. Cosme Argerich", Buenos Aires, Argentina.
Enrique de-Madaria, Investigación Sanitaria y Biomédica de Alicante (ISABIAL - Fundación FISABIO), Alicante, Spain.
Bechien U. Wu, Kaiser Permanente, Pasadena, CA, USA.
Gregory A. Cote, Medical University of South Carolina, Charleston, SC, USA.
Gong Tang, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Georgios I. Papachristou, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: georgios.papachristou@osumc.edu.
Gabriele Capurso, Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; Digestive and Liver Disease Unit, Sant Andrea Hospital, Rome, Italy.

Abstract

BACKGROUND: The clinical features and outcomes of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) are not well-established. OBJECTIVE: To evaluate the clinical characteristics of HTG-AP in an international, multicenter prospective cohort. METHODS: Data collection was conducted prospectively through APPRENTICE between 2015 and 2018. HTG-AP was defined as serum TG levels >500 mg/dl in the absence of other common etiologies of AP. Three multivariate logistic regression models were performed to assess whether HTG-AP is associated with SIRS positive status, ICU admission and/or moderately-severe/severe AP. RESULTS: 1,478 patients were included in the study; 69 subjects (4.7%) were diagnosed with HTG-AP. HTG-AP patients were more likely to be younger (mean 40 vs 50 years; p < 0.001), male (67% vs 52%; p = 0.018), and with a higher BMI (mean 30.4 vs 27.5 kg/m; p = 0.0002). HTG-AP subjects reported more frequent active alcohol use (71% vs 49%; p < 0.001), and diabetes mellitus (59% vs 15%; p < 0.001). None of the above risk factors/variables was found to be independently associated with SIRS positive status, ICU admission, or severity in the multivariate logistic regression models. These results were similar when including only the 785 subjects with TG levels measured within 48 h from admission. CONCLUSION: HTG-AP was found to be the 4th most common etiology of AP. HTG-AP patients had distinct baseline characteristics, but their clinical outcomes were similar compared to other etiologies of AP.